Overview

Blepharoplasty is one of the most common facial plastic surgical procedures performed today. The reason for this is that facial aging occurs first in one's eyelids with heavy bags sometimes occurring as early as in the patient's 20's. As time goes on, there is heavy lidding of the upper lids. If this is not corrected, it may lead to visual obstruction later generally in the 50's or 60's. Dramatic new procedures are available utilizing either hidden or inconspicuous incisions and resultant scars. Blepharoplasty is performed alone in the younger patient and may be combined with other surgery such as the facelift or brow lift. Many times, laser surgery is utilized to give a more youthful tighter appearance in the eyelid skin and crow's feet.

Indications

Eyelid fat bags are the early indication for eyelid surgery. These fat bags, normally restrained by supporting eyelid tissues, herniate or project outward on the cheeks and present themselves as unsightly protrusions. They are generally worse at night or during the day if the patient has ingested salty foods or alcohol leading to fluid retention. This excess fluid causes the fat bags to appear larger as they are actually holding more tissue water.

As time goes on, The presence of the bags create a distention and stretching of the lower eyelid skin due to the constant increase and decrease of the bags which act somewhat like a battering ram. This leads to lower eyelid crepe-like, distended skin.

The upper lid skin is involved with a similar mechanism plus the influence of the eyebrow position. This skin also become distended and stretched. In addition as the eyebrow descends, due to aging and active frown musculature (see the section on Browlifts), there is an apparent increase in skin. This is due to the descending brow pushing a wave of eyelid skin downward into the eyelid area. This excess skin is not only unsightly, but may lead to a peripheral visual field obstruction as well, much the same as a horse's blinders.

The indications for eyelid surgery, therefore are cosmetic and functional when vision is impaired.

Preparation

Any patient over forty may be asked to see their internist for medical clearance. Special tests will be requested of all patients to insure that they are healthy and that there will be satisfactory healing. Smoking and aspirin ingestion is prohibited for two weeks before and two weeks after surgery. Aspirin will cause more bruising and bleeding, thus prolonging the recovery period. It has been found that smoking may lead to delayed healing and more noticeable scars. Occasionally, a hyperbaric oxygen treatment is recommended for smokers to prevent postoperative complications.

You will be given prescriptions for homeopathic and pharmaceutical preparations to prepare your system for surgery.

Anesthesia

We are recommending General Anesthesia for our patients, so that there is complete rest, safety, and no discomfort during the procedure. Occasionally, the Blepharoplasty when done alone, is performed under intravenous sedation and local, should the patient desire to be conscious during the procedure. However, if eyelid surgery is combined with other plastic surgery, general anesthesia is the recommended choice. You will have an opportunity to discuss these options with Dr. Sokol and our Anesthesia staff.

Procedure

You will enter the Nova Surgicenter through a private and discreet entrance. After routine charting is accomplished, you will meet with Dr.Sokol. He will review your photos with you and with a mirror explanation and your input, he will point out the areas of aging in your eyelids. He will then mark the areas to be operated with special indelible ink. The anesthesiologist will then prepare you for surgery with all the special monitors, medicines and equipment to insure the procedure is not only safe for you, but comfortable as well.

The surgical incisions will follow the crease lines in the upper lids. When healed, the scar is quite inconspicuous. For the first several months, you may wish to camouflage the scar with some eyelid blushon makeup. The lower lid incisions may be hidden when there are only fatbags present. This surgery may be combined with laser surgery of the lower eyelid skin and crows feet. If there is excess skin and eyelid bags, an incision is made just under the eyelash margin. This scar generally heals with a pale inconspicuous line. The surgery for both upper and lower eyelids takes approximately one to two hours.

Postoperative Period

Following the procedure you will be taken into our recovery room. You will be place on a special bed with your head elevated. A blanket of circulating warm air will increase your sense of well being and comfort. You will be continually monitored and observed until the staff is satisfied with your early recovery and that your monitors and vital signs are stabilized. This will take approximately two hours.

After Care

After Care Facilities - Many patients elect to use an aftercare facility in a nearby hotel. These are fully staffed with 24 hour expert nursing care. All patients using these facilities have had cosmetic surgical procedures. Thus the nurses are experienced with the needs of this surgery and highly attuned to your privacy and comfort. Meals and transportation to your postoperative visits are provided. You will be seen by the nursing staff the next day to inspect your surgical site, provide a dressing change if required and arrange for your next visit.

If you live less than one hour away from the office, you may wish to go home with a home care nurse which will be arranged for you. If you have a family member or friend that can devote the time to you, this may be a preferable aftercare situation for you. If you live more than one hour away and/or you have had additional surgery, ie facelift or liposuction, you may wish to stay at least one night in a nearby hotel. Your nurse (or relative) can stay here with you. You will be seen the next day by our staff to inspect your surgical site and provide an appropriate dressing change.

Pain

Many patients experience little or no pain following the laser. Everyone is different and you may feel some discomfiture. You will be provided with a prescription for pain pills that will assist you during the first 48 hours. This is the period that some patients experience pain.

Activity

It is recommended that for the first 3-4 days that you sleep on your back with the head elevated on one or two pillows. This will reduce the swelling and lead to a more comfortable and shorter postoperative period. No bending over, keep your head above your heart at all times. Cold compresses are recommended for your eyelids. The first two days, they should be used continuously when you are not sleeping. For the next two days, one hour three times a day. Thereafter, cold and warm may be alternated for an additional day or two. Special drops and ointments are prescribed. The ointment is recommended at night and the drops three times daily, both for three or four days. You are not to read anything for two days. Television is all right as your eyes do not go from side to side as they do in reading.

No exercise, intimacy, emotionally charged situations, or alcohol is permitted for the first 7-10 days. No smoking is permitted for 14 days. This will insure a safer, shorter postoperative period, without increased bruising or delayed healing.

Although every patient heals differently, makeup is generally allowed after the sutures are removed by day 6. A return to your employment or social schedule can occur as soon as you are comfortable with you appearance. We generally recommend that the patient take at least 7 to 10 days before returning to their social or work routine.

Complications

Complications are rare after eyelid surgery. Some of the more well known are bleeding or hematoma requiring drainage, infection, and irregularity of healing. The latter are quite infrequent but certainly more severe; as blindness, ectropion or eyelid pull down, inability to open or close the eyelids and diploplia or double vision can result. These complications may require further operative and or non operative treatment. They also may result in permanent unfavorable results. As mentioned, these permanent complications are quite rare.

Results

The goal of Blepharoplasty to provide you with a more attractive, youthful eyelid without bags and/or excess skin. For the patient with visual obstruction, the goal is to help that patient see better.

One of the nicest compliments that can be paid to our patients undergoing eyelid surgery is that they look rested. Sometimes comments are made that the patient has beautiful eyes. This is frequently heard in those individuals with brow descent or heavy upper lids that have obscured or hidden the eye for years.